An Awakened Heart Psychological Approaches Tomentalhealth Wellness LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

SW 11227 Issued in FL

Legal business name

AN AWAKENED HEART PSYCHOLOGICAL APPROACHES TOMENTALHEALTH WELLNESS LLC

Practice address

4100 W Kennedy Blvd
327
Tampa, FL 33609-2288

Phone

(727) 692-7364

NPI assigned

Jun 21, 2013

Last updated

Jul 9, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Keesha Monaie Sullivan, LCSWNPI 1053653840

Title

Owner

Phone

(727) 692-7364

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keesha Monaie Sullivan, LCSW

  • Clinical Social Worker
  • Tampa, FL
  • NPI 1053653840
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1841639929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8450 112TH ST APT 104",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 W KENNEDY BLVD",
            "address_2": "327",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336092288",
            "telephone_number": "727-692-7364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AN AWAKENED HEART PSYCHOLOGICAL APPROACHES TOMENTALHEALTH WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KEESHA",
        "authorized_official_middle_name": "MONAIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-692-7364",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "SW 11227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Tampa, FL
• Providers in Tampa, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.